I was asked a couple of days ago if I am anti-homebirth now, that this series sounds snarky and like I am really telling women that homebirth isn’t safe at all anymore. Really, really, if I didn’t think there were any homebirth midwives that were qualified to attend to women, I would totally say so. What I’m saying here is what I believe will help women find the right provider for themselves as well as finding one that can keep the woman and her baby safe.

When I talk about the midwife keeping the mom and baby safe and alive, I am not just speaking about during the labor, birth and postpartum time exclusively, but also during the pregnancy. It takes a great deal of skill and experience to catch the nuances of a pregnancy stepping out of the bounds of normal, too. Knowing when to intervene and/or refer to a doctor is a crucial skill. I’m writing this series for those that want a homebirth and who think they might want one… giving the insider information that can help aid a woman’s/family’s search.

As I’ve said before, there are trade-offs when choosing either home or hospital births. Each one has their complication factors, either created or surprise. Each woman has the responsibility (and right!) to weigh the risks and to decide for herself within which risks she is willing to work –and live with for the rest of her life. Many aspects of our lives are risky and we weigh them with the potential benefits every single day. This home vs. hospital choice is no different.

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Yes, that is me, but not quite with a buzz cut. I was sick for a little more than 3 years with Disseminated Coccidiomycosis and on 800 mg Diflucan every single day for 3 years (other -azoles off and on, too) and a side effect of -azoles is hair loss, similar to chemo. I don't miss those days AT ALL.

Since my hair's grown back, it's wavy now! The more recent pics, you can see how my hair is just this side of curly. All natural! Love it!

Emily: What "more" testing do midwives do? There are standards and there are outside of standards. Homebirth midwives, BY FAR, do less testing than even the most liberal of OB or CNM practices. Everything from prenatal testing to sonos to NSTs and BPPs. What testing is it you think midwives do that doctors don't?

Midwives (at least where I'm apprenticing) refer women out for NSTs and BPPs when there's the slightest indication they might be needed. They also do urine dips at every visit, and send in for urinalysis if there are abnormal values, which I understand most OBs don't do. They monitor nutritional intake, which while it isn't a test, is very relevant in terms of understanding the results of blood work. Multiple CBCs with diff, especially at the beginning of the pregnancy and around 28 weeks, to get a baseline and then check for adequate blood volume expansion. If there are any issues, they'll do a fresh CBC every few weeks, because PIH or pre-eclampsia requires referral to a perinatologist. They refer for sonograms, as well, though women refuse this test some of the time. They do routine vaginal exams as well, though not many, particularly in primips for pelvimetry purposes. That is only used to inform the midwife regarding the shape of the pelvis and to check abnormalities, since different pelvic types often stall at different points in labor and can benefit from specific positioning.

I may be missing some, as I'm only a second-year student and began my apprenticeship just 2 months ago. But this is the kind of testing I've seen. My preceptor also refuses clients who decline basic testing, as she views it as unsafe.

Emily: Not sure who told you docs don't do what you described as your midwives do, but they are absolutely incorrect. And why in the world would a doctor NOT send in abnormal urines? Are you saying your midwives send in ALL urines with trace or +1 proteins? +1 glucoses? Or do you mean with nitrates and ketones? Be specific, please. And perhaps someone is not aware the urine is sent in because it's sent in from the sample they've left in the door in the wall, not in a separate sample needed because the client threw out her first urine sample herself. (And I am *not* implying it's not cool for a woman to dip her own urine. I am of the belief that the more of her chart she fills out herself, the better.

Standard labs:- Prenatal panel at first visit- Pap + STI testing with vaginal exam, incl "pelvimetry" (if you want to call it that anymore)- Early sono- CVS if requested- AFP- 28 week labs, including GTT, CBC + diff, + Serology again + antibodies (again)- GBS- Sonos if necessary - NSTs & BPPs if necessary- Vaginal exams (*not* "tests," by the way), if a more interventive doc, starting at 36 or 37 weeks and weekly thereafter OR if less interventive, starting at 39 or 40 weeks and again if indicated by forward movement OR after 41 weeks, as an induction seems more likely- If any aspects of the pregnancy move out of the realm of normal, tests are offered/ordered along the way.

What is there you see that isn't offered in midwifery care? And re: risking out for non-compliance, that's actually not a bad idea since these *are* homebirths and those should be completely normal... and how can you know if they're normal if you haven't tested for it?